| NPI | 1215938006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103300812) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103300812) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2022-09-12 |