| NPI | 1013924836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO00000249) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO00000249) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-07-21 |