| NPI | 1942310008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WA PO00000798) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000798) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-05-02 |