| NPI | 1093952616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60159067) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60159067) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006000) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3542) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2020-01-27 |