| NPI | 1487724324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000957) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD000957) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2015-12-03 |