| NPI | 1194712349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000747) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 00747) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2021-07-24 |