| NPI | 1346711702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: COA00201) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CPO03325) |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2018-12-11 |