| NPI | 1366869893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60830095) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5353) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60830095) | |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2021-11-29 |