NPI | 1235132705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA POD0000317) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO0000317) |
Enumeration Date | 2005-05-27 |
Last Update Date | 2010-11-30 |