| NPI | 1205827979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO 0000617) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO POD.0000617) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-12-06 |