| NPI | 1396794459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 604) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 604) |
| 224P00000X Prosthetist (Licence: TX 604) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-09-18 |