| NPI | 1871760603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP154131) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO 60466887) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2015-08-20 |