| NPI | 1447212410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000111) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000110) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-08-07 |