| NPI | 1205212537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 251293) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005797) |
| 211D00000X Assistant, Podiatric | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ NS) | |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2019-08-19 |