| NPI | 1922556562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NJ 45PO00016200) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NJ 45PO00016200) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2016-09-12 |