| NPI | 1275644585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: OR OR DP00303) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WA WA PO00000651) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-10 |