| NPI | 1801283569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC CPO03757) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC CO005502) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2016-04-29 |