| NPI | 1427696392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MT MED-POD-LIC-136989) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001439) |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2024-03-14 |