| NPI | 1649141920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224L00000X Pedorthist (Licence: AZ CPED2705) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: AZ CPED2705) |
| 222Z00000X (Licence: AZ CPED2705) | |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-09-17 |