| NPI | 1639668833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO61309234) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO61309234) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2022-07-13 |