| NPI | 1831297928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000746) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO0000746) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-10-21 |