| NPI | 1225480148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 345) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: RI LPR00161) |
| Enumeration Date | 2016-07-02 |
| Last Update Date | 2019-06-26 |