| NPI | 1598757551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA PD0113) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA DPMPD0113) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-03-06 |