| NPI | 1467783217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213.000039) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211.000026) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2010-01-19 |