| NPI | 1902393614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: MS C50109) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: MS C50109) |
| 224L00000X Pedorthist (Licence: MS C50109) | |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |