| NPI | 1376663534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC cpo02116) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC cpo02116) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2019-06-18 |