| NPI | 1952166118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: PA PO000109) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: PA OH000163) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-02-16 |