| NPI | 1417056847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000605) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000605) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-09-11 |