| NPI | 1487851283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: IL 211-000025) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: IL 213-000028) |
| 224P00000X Prosthetist (Licence: IL 211-000025) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2008-07-10 |