| NPI | 1487246369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 229N00000X Anaplastologist |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| 224900000X Mastectomy Fitter | |
| 224L00000X | |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2022-08-30 |