| NPI | 1730859562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 2142) |
| Additional Taxonomies | 222Z00000X (Licence: TX 2142) |
| 224P00000X Prosthetist | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: TX 101801) | |
| 222Z00000X | |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2025-07-18 |