| NPI | 1922004381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA DPM.PD0100) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA PD0100) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-11-13 |