| NPI | 1619951456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00128) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: OR DP00128) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP00128) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2008-02-05 |