| NPI | 1033612791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA ORTH.OI.60819114) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS60912919) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2021-12-10 |