| NPI | 1700137676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: FL POR85) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: FL POR85) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-11-02 |