| NPI | 1245854587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 1320-25) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1320-25) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-01-24 |