| NPI | 1679675003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: CA 1242) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA 1242) |
| 224P00000X Prosthetist (Licence: CA 1242) | |
| 225400000X Rehabilitation Practitioner (Licence: CA 1242) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2010-02-18 |