| NPI | 1083674857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 260) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 245) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2024-05-01 |