| NPI | 1447815832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA TS61476595) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-10-06 |