| NPI | 1124400858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60788616) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO60788616) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2022-12-05 |