| NPI | 1841824521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO04745) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CO005925) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2022-11-14 |