| NPI | 1649533183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO60986928) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E5200) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-01-27 |