| NPI | 1891338133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TN 200) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: TN 221) |
| 224P00000X Prosthetist (Licence: GA 120) | |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2019-10-18 |