| NPI | 1710283858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CO001238) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2013-10-14 |