NPI | 1356300065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 222Z00000X Orthotist (Licence: WA OI00000029) |
Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS00000028) |
Enumeration Date | 2006-03-21 |
Last Update Date | 2007-07-08 |