| NPI | 1194475202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 211D00000X Assistant, Podiatric |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1553) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-06-22 |