| NPI | 1023458304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001344) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN 788) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2019-04-12 |