| NPI | 1710158043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CP000845) |
| Additional Taxonomies | 1744P3200X Specialist Prosthetics Case Management |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |