| NPI | 1457671620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 169, Prosthetics) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 8552, Physical Thera) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2010-06-10 |