| NPI | 1629110473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001076) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA POD001076) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: GA POD001076) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001076) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: GA POD001076) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2018-07-09 |