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 |