| NPI | 1962761973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: DE CPO01700) |
| Additional Taxonomies | 224L00000X (Licence: DE CPO01700) |
| 224P00000X Prosthetist (Licence: DE CPO01700) | |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2012-05-10 |