| NPI | 1639167620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: NC CP001225) |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| 224P00000X Prosthetist (Licence: NC CP001225) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2010-08-26 |