| NPI | 1649507328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: IL 211.000222) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: IL 213.000389) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2021-08-12 |