| NPI | 1518908573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO00000207) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000207) |
| 213ER0200X Podiatrist, Radiology (Licence: WA PO00000207) | |
| 213ES0131X (Licence: WA PO00000207) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-05-01 |