| NPI | 1376540666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PA CPO02528) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: PA CPO02528) |
| 225200000X Physical Therapy Assistant (Licence: PA TE001848L) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2008-10-14 |