| NPI | 1477512184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000433) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000413) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-09-11 |