| NPI | 1255542668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CPO851) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA CPO851) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2007-07-09 |