| NPI | 1679979249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN PRO034) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT045) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2014-11-10 |