| NPI | 1063428779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: WA PO00000460) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO460) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2016-03-29 |