| NPI | 1588813315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CP003523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 5335) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2008-09-17 |