| NPI | 1437660834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: FL PRO114) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC C52629) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2017-10-12 |