| NPI | 1235542788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO61311539) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5326) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-09-13 |