| NPI | 1003050899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO 707) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01521) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2020-02-28 |