| NPI | 1487155453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: IL 211.000048) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: IL 213.000061) |
| 224L00000X Pedorthist (Licence: IL 212.000042) | |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2018-02-26 |