| NPI | 1871113787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001468) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E5843) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-08-11 |