| NPI | 1588660609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 650) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: WI 650) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2019-05-22 |