| NPI | 1093773236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management (Licence: CA CO3156) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA CO0003156) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-06-17 |