| NPI | 1295766020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA 95-3369810) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA 95-3369810) |
| 222Z00000X Orthotist | |
| 224P00000X Prosthetist | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-09-22 |