| NPI | 1215011218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NM POD417) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP 00375) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CO POD.0000831) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-10-01 |