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 |