| NPI | 1881321750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: WA OI61322979) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WA PS61322980) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-08-15 |