| NPI | 1164745824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 1200396) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 345) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0738) | |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2021-03-26 |