| NPI | 1871660050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: DE RFOM0053) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: DE RFOM0053) |
| 225000000X Orthotic Fitter (Licence: DE RFOM0053) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |