| NPI | 1932409505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: SC C26262) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: SC C26262) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2016-11-08 |