| NPI | 1710084272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: MD C49836) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: MD C49836) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2022-02-21 |