| NPI | 1790030716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60697482) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 860) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 355) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 12-00413) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2017-01-27 |