| NPI | 1982683322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: WA po00000750) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WA po000000750) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2020-07-14 |