| NPI | 1144262148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001080) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN TN0664) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-07-03 |