| NPI | 1114986825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA OI00000205) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS00000307) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |