| NPI | 1164652830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0780) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0780) |
| 213E00000X Podiatrist (Licence: DE E10000213) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: DE E10000213) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: DE E10000213) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2020-09-28 |