| NPI | 1154858363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60756338) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI60739280) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2022-07-21 |