| NPI | 1487822342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 1) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management (Licence: TX 001) |
| 222Z00000X Orthotist (Licence: TX 1) | |
| 224P00000X Prosthetist | |
| 225000000X Orthotic Fitter (Licence: TX 1) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2020-08-25 |