| NPI | 1689916728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60653492) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213E00000X Podiatrist (Licence: WA PO60653492) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-05-20 |