| NPI | 1376697193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX CP003005) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: TX CP003005) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-09 |