| NPI | 1568571180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC CPO 02170) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC CPO 02170) |
| 222Z00000X Orthotist (Licence: NC CPed0222) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-04-26 |