| NPI | 1245448935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60084293) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR LL16573) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2025-07-16 |