| NPI | 1376007849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: OH LP.00116) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: COA00304) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2020-08-31 |