| NPI | 1730562083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0131X Podiatrist Foot Surgery (Licence: GA POD001392) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2020-08-14 |