| NPI | 1497748412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 589) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 589) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-09-23 |