| NPI | 1194212951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD305018) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA 309583) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2024-12-02 |