| NPI | 1093903569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CP002973) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA CP002973) |
| 225500000X Specialist/Technologist (Licence: CA CP002973) | |
| 224P00000X Prosthetist | |
| 225000000X Orthotic Fitter (Licence: CA CP002973) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2012-02-14 |