| NPI | 1891738381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC 2673) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC C26289) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-08-27 |