| NPI | 1205894391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO-3185) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL PO3185) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-03-14 |