| NPI | 1346251303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: WI 692-025) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 692) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2021-11-18 |