| NPI | 1700973518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 213) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1024800) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-08-19 |