| NPI | 1174712764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CPO02952) |
| Additional Taxonomies | 222Z00000X Orthotist |
| 222Z00000X Orthotist (Licence: CA CPO02952) | |
| 225000000X Orthotic Fitter (Licence: CA CPO02952) | |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2012-02-07 |