| NPI | 1609028422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 940) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 940-025) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 940-25) | |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2024-04-10 |