| NPI | 1669872925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WA PO60714901) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric (Licence: WA PO60714901) |
| Enumeration Date | 2014-08-23 |
| Last Update Date | 2025-05-08 |