| NPI | 1154737344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT 53380) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 073986) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-07-21 |