| NPI | 1144615907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1150-25) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 1150-25) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: WI 1150-25) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-12-29 |