| NPI | 1538374848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: 84-190) |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2021-11-09 |