| NPI | 1053344929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 449) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ dpm 449) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: AZ 449) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-07-31 |