| NPI | 1669613360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA CO004897) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225000000X Orthotic Fitter (Licence: WA CO004897) | |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2012-01-10 |