| NPI | 1538143698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: WA PO00000213) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: ID P 90) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2011-12-12 |