| NPI | 1952314528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: CA CP1386) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: CA CP1389) |
| 222Z00000X Orthotist (Licence: CA CP1389) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |