| NPI | 1003240797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA OI60346812) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS60543865) |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2016-03-10 |