| NPI | 1861729782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CPO01732) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NC 1732) |
| 222Z00000X Orthotist (Licence: CPO01732) | |
| 224L00000X Pedorthist (Licence: CPED0326) | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2012-03-06 |