| NPI | 1790790376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000775) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO00000775) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-06-30 |