| NPI | 1699297416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: 003980) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-05-09 |