| NPI | 1023547957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SC 801) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: LA 325701) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2026-06-22 |