| NPI | 1043565922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2012024470) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 12-00407) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2015-12-09 |