| NPI | 1689388019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC CPO05117) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC CO006583) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2023-02-06 |