| NPI | 1770674673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR OR DP00249) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA WA PO00000597) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-10 |