| NPI | 1770650822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO00000562) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO00000562) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-07-28 |