| NPI | 1780976373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001168) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001168) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA POD001168) | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2020-03-10 |