| NPI | 1124036934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001232) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 003589) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2016-04-09 |