| NPI | 1679700108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-213) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc005865) |
| 213E00000X Podiatrist (Licence: WA PO60107600) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2016-03-07 |