| NPI | 1205298213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001311A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WA PO61665595) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2025-07-17 |