| NPI | 1104486950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 2081) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 264) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2023-02-06 |