| NPI | 1912107012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X (Licence: CA 001184) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CA 00184) |
| 225000000X Orthotic Fitter (Licence: CA 00184) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2007-07-18 |