| NPI | 1619128170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000447) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000446) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2023-12-06 |