| NPI | 1366673303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 1273) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX 1273) |
| 247200000X Technician, Other (Licence: TX ATP94445) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2022-09-08 |