| NPI | 1578980991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: WA PS00000468) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: WA OI00000469) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2014-03-24 |