| NPI | 1528216892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: GA 000084) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: GA 000084) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2021-04-19 |