NPI | 1407906654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00270) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: WA P000000561) |
Enumeration Date | 2007-01-11 |
Last Update Date | 2022-10-03 |