| NPI | 1063463982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 384) |
| Additional Taxonomies | 213ES0131X (Licence: NC 384) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-07-01 |