| NPI | 1932112463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000810) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP00374) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-09-26 |