| NPI | 1013697002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CPO03356) |
| Additional Taxonomies | 224P00000X Prosthetist |
| 222Z00000X Orthotist (Licence: CA CPO03356) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-07-24 |