| NPI | 1609444074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: OH COS.165572) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management (Licence: OH COS.165572) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-06-14 |