| NPI | 1124116231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00317) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO00000596) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |