| NPI | 1083696090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000987) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: GA POD000987) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2009-04-22 |