| NPI | 1972584977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000722) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 000722) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-07-23 |