| NPI | 1184697088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000734) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA P000000743) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2016-05-27 |