| NPI | 1265715593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60197750) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI6027313) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2023-06-19 |