| NPI | 1952550295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60211118) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO60211118) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: WA PO60211118) | |
| 213ER0200X Podiatrist Radiology (Licence: WA PO60211118) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006067) | |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2024-04-02 |