| NPI | 1952607426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: CA CO002151) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2012-08-10 |