| NPI | 1053574392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WV 02207) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103301039) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2022-05-05 |