| NPI | 1578110508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 222Z00000X Orthotist |
| 1744P3200X Specialist Prosthetics Case Management | |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2024-02-26 |