| NPI | 1851733323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: MD c49842) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: MD c49842) |
| 224L00000X Pedorthist (Licence: MD c49842) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2022-05-18 |