| NPI | 1245476597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CPO02042) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA CPO02042) |
| 224L00000X (Licence: CA CPO02042) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CA CPO02042) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2014-05-22 |