| NPI | 1386744324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000340) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO0000034O) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2018-06-13 |