| NPI | 1174843593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: WI 1020-25) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1020-25) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2019-02-26 |