| NPI | 1902097645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: WA PS00000264) |
| Additional Taxonomies | 222Z00000X (Licence: WA OI00000263) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-10-27 |