| NPI | 1407247240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: FL POR 160) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: FL POR 160) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2015-03-16 |