| NPI | 1609846237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-274) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD000883) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-09-12 |