| NPI | 1235100116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MD 00969) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 00969) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: MD 00969) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-12-22 |