| NPI | 1649228230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRO16) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT16) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2008-01-07 |