| NPI | 1053549253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5085) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006140) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-11-29 |