| NPI | 1649069501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRo00000000296) |
| Additional Taxonomies | 222Z00000X (Licence: TN ORT00000000304) |
| Enumeration Date | 2025-05-06 |
| Last Update Date | 2025-05-06 |