| NPI | 1881949907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1050) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1050) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2016-11-16 |