| NPI | 1225342751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 000885) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3496) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2024-04-04 |