| NPI | 1548254329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00332) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO00000795) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2013-04-08 |