| NPI | 1336612753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60560910) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI60560917) |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2019-01-08 |