| NPI | 1447782339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: OK c52463) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2019-04-12 |