| NPI | 1871776427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: TX 130) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TX 130) |
| 224P00000X Prosthetist (Licence: TX 130) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2023-08-24 |