| NPI | 1932474749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: VA CPO2382) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: VA CPO2382) |
| 225000000X Orthotic Fitter (Licence: VA CPO2382) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-03-12 |