| NPI | 1679520423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: OK 331034873) |
| Additional Taxonomies | 224P00000X Prosthetist |
| 225000000X Orthotic Fitter (Licence: OK 331034873) | |
| 229N00000X Anaplastologist | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2012-04-02 |