| NPI | 1780683136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 771) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 209) |
| 213E00000X Podiatrist (Licence: GA POD001283) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2019-03-04 |