| NPI | 1336637040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PA PO000002) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: PA OH000004) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2018-04-27 |