| NPI | 1578180584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: WA PO61513723) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: PA SC007106) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007106) | |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2024-10-01 |