| NPI | 1336339365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS 00000189) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI 00000188) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2013-03-14 |