| NPI | 1568777175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60398534) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006241) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60398534) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2013-09-17 |