| NPI | 1184252512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL 4489) |
| Additional Taxonomies | 213EP0504X Podiatrist Public Medicine (Licence: FL PO4489) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-11-25 |