| NPI | 1174623714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OR DP00222) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO00000601) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2022-02-04 |