| NPI | 1306271838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA OI60339265) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS60452668) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2014-04-02 |