| NPI | 1538339395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR 154) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA 329) |
| 213E00000X Podiatrist (Licence: CA E3266) | |
| Enumeration Date | 2008-03-08 |
| Last Update Date | 2008-03-08 |