| NPI | 1548866882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60697257) |
| Additional Taxonomies | 222Z00000X (Licence: WA OI60545479) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2020-12-10 |