| NPI | 1811991169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CPO01752) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: CA CPO01752) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2014-03-04 |