| NPI | 1720263312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: TX 56) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX 56) |
| 224P00000X Prosthetist (Licence: TX 56) | |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2019-12-18 |