| NPI | 1104816941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000776) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA POD000776) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-04-07 |