| NPI | 1730488719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: AZ CP003631) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: AZ C51568) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2014-05-23 |