| NPI | 1073577854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 827-025) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WI 827) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 827-025) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2011-02-11 |