| NPI | 1356669378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: VA CPO 02136) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: VA cpo 02136) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2015-04-20 |