| NPI | 1316250319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000410) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000409) |
| 225000000X Orthotic Fitter (Licence: WA PS00000410) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2012-01-10 |