| NPI | 1558810754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CO005278) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA CPO03792) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |