| 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 |