| NPI | 1619201274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRO0000000072) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT0000000138) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2019-12-19 |