| NPI | 1730680547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: IL 213.000345) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: IL 211.000313) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2025-01-15 |