| NPI | 1922439983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: KY LPO-308) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: KY LO-285) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2014-07-16 |