| NPI | 1619372224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX LPO1505) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX LPO1505) |
| 224P00000X Prosthetist | |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2022-07-15 |