| NPI | 1093711491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: WI 604-025) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 604-025) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2023-03-07 |