| NPI | 1275077851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60704842) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI60704848) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |