| NPI | 1548571136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP151747) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO60127687) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP151747) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2020-11-03 |