| NPI | 1659526879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PR CP003225) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: PR CFO01075) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2008-12-02 |