| NPI | 1063906394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SD 244) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 091712) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-07-12 |