| NPI | 1164638920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3097) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 778) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-10-04 |