| NPI | 1245475748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CPO00577) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA CPO0057) |
| 225000000X Orthotic Fitter (Licence: CA CPO0057) | |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2012-02-10 |