| NPI | 1457577991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CP 1179) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA CP 1179) |
| 225000000X Orthotic Fitter (Licence: CA CP 1179) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |