| NPI | 1013261684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60317586) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ PD-000950) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2024-12-09 |