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 |