| NPI | 1700568284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA C52271) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA COA00648) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2023-08-09 |