| NPI | 1255570495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA DPM.200030) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 3359) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2013-06-13 |