| NPI | 1366513905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA 395) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: GA 395) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-08-25 |