| NPI | 1780677047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000701) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA po00000701) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2014-05-13 |