| NPI | 1760607428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 229N00000X Anaplastologist |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| 224P00000X Prosthetist | |
| 246ZA2600X Specialist/Technologist, Other, Art, Medical | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-10-31 |