| NPI | 1851837652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: TN CPO2599) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN ORT0000000099) |
| 224P00000X Prosthetist (Licence: TN PRO0000000077) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2022-07-21 |