| NPI | 1649352527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA P000000325) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: HI p206) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2016-04-05 |