| NPI | 1376179903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PA PO000282) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: PA OH000387) |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2020-03-16 |