| NPI | 1639240641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 459) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 459) |
| 213ES0131X (Licence: WI 459) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-09-11 |