| NPI | 1639209992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NY CPO00981) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NY CPO00981) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-12-11 |