| NPI | 1902930175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: DE CPO02314) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: MD C15272) |
| 222Z00000X Orthotist (Licence: DE CPO02314) | |
| 224P00000X Prosthetist (Licence: MD C15272) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-04-24 |