| NPI | 1427065697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WA 252-01:0000320) |
| Additional Taxonomies | 213ES0131X (Licence: WA 252-01:0000320) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-02-24 |