| NPI | 1174870406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 244073) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00324700) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00442) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2021-05-13 |