| NPI | 1417259201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO-1290) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CPO-1290) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2013-05-16 |