| NPI | 1821269762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: FL PO 00039) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: FL PO 00039) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2009-01-27 |