| NPI | 1063856136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SD 225) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2055) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 922) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2015-01-05 |