| NPI | 1528434107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CPO00922) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA CPO00922) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2015-08-18 |