| NPI | 1629016365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000440) |
| Additional Taxonomies | 222Z00000X (Licence: WA OI00000421) |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-02-13 |