| NPI | 1194816140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA 000814) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 246) |
| 213E00000X Podiatrist (Licence: TX 1541) | |
| 213E00000X Podiatrist (Licence: CA E-3603) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-12-17 |