| NPI | 1578182812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO61426650) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WA PO61426650) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO61426650) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-07-07 |