| NPI | 1275704686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CO2798) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA CO2798) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-07-25 |