| NPI | 1265164198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO00000166) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO00000166) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-12-13 |