| NPI | 1376544254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60211761) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MT 87) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-05-20 |