| NPI | 1447585518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: VA CPO02283) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: VA CPO02283) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |