| NPI | 1467673715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MN CPO 1904) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: MN CPO 1904) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2012-01-26 |