| NPI | 1063493559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WA 91-1813864) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WA PO00000297) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2016-04-08 |