| NPI | 1548675192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60876317) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PL 60464948) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2020-12-02 |