| NPI | 1619394061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OR DP190571) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP190571) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2022-02-04 |