| NPI | 1720589617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213000071) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211000176) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2018-02-26 |