| NPI | 1598916389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: MD C46875) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: MD C46875) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2012-04-10 |