| NPI | 1760135230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO05234) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CO006440) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-07-06 |