| NPI | 1700313475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001338) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006861) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001338) | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2024-08-27 |