| NPI | 1851933253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO61476547) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WA PO61476547) |
| 213E00000X Podiatrist (Licence: WA PO61476547) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2025-02-19 |