| NPI | 1093804817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: GA POD001182) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: SC 569) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-09-07 |