| NPI | 1407093859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: OH LPO306) |
| Additional Taxonomies | 222Z00000X Orthotist |
| 225000000X Orthotic Fitter | |
| 222Z00000X Orthotist (Licence: OH LPO306) | |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2015-06-01 |