| NPI | 1659800100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: OH 00378) |
| Additional Taxonomies | 1744P3200X Specialist Prosthetics Case Management |
| 224P00000X Prosthetist | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-04-24 |