| NPI | 1952539769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60305797) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 21893889) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-09-05 |