| NPI | 1013246701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2011014616) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2011014616) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2022-09-14 |