| NPI | 1396737136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL AL000110) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL AL000110) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-06-22 |