| NPI | 1215282652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301137) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103301137) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2018-11-27 |