| NPI | 1154341477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 000816) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: TX 1544) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-09-21 |