| NPI | 1699775700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC PNO695) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC PNO695) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2008-01-08 |