| NPI | 1093194425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM POD434) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM T-1555) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2021-02-25 |