| NPI | 1710988779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4249) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD000496) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD000496) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2023-10-24 |