| NPI | 1457356305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 883025) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 883025) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: WI 883025) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-02-16 |