| NPI | 1174515456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD-000220) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0220) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2022-08-19 |