| NPI | 1710178058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000195) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000216) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-09-19 |