| NPI | 1417591843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WY CPO04185) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WY CPO04185) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2024-03-19 |