| NPI | 1518964220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: GA 01521) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: GA 01521) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-11-07 |