| NPI | 1528327319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MS 80226) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60540475) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2017-01-03 |