| NPI | 1487631586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000022) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA 0I00000023) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-11-20 |