| NPI | 1982795050 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP00247) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP00247) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-01-05 |