| NPI | 1912301631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60720189) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO60720189) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 17961-875) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2023-05-08 |