| NPI | 1104350883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA 326864) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA 326824) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001453) | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2021-07-28 |