| NPI | 1366973463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: PA OH000281) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: PA PO000194) |
| 224P00000X Prosthetist (Licence: IL 211.000165) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |