| NPI | 1023388451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000251) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: WA PH00010473) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-01-02 |