| NPI | 1538376108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 101161) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management (Licence: TX 16) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2012-02-02 |