| NPI | 1720655459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO03568) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CPO03568) |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-06-15 |