| NPI | 1144673575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5532) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY P02475) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2022-02-07 |