| NPI | 1174514970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000822) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 0924) |
| 213E00000X Podiatrist (Licence: AZ 0557) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000822) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2020-01-06 |