| NPI | 1780955617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS60240556) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: WA OI60240559) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2013-05-17 |