| NPI | 1568642072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: AR OPP00268) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: AR OPP00268) |
| 224P00000X Prosthetist (Licence: AR OPP00268) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2018-04-11 |