| NPI | 1508903337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: AR 00083) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: AR 00083) |
| 225000000X Orthotic Fitter (Licence: TX 334) | |
| 1744P3200X Specialist Prosthetics Case Management (Licence: 00075) | |
| 174400000X Specialist (Licence: 0056) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2008-02-05 |