| NPI | 1760649602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001364) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 626) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301013) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2022-01-26 |