| NPI | 1770775868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000355) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI00000335) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2007-12-10 |