| NPI | 1386020832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001537) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006676) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2023-03-20 |