| NPI | 1215968979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001233) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 629) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-01-10 |