| NPI | 1417994500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: VA CPO 2469) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: VA CPO 2469) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2013-04-03 |