| NPI | 1235461294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NE 326) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MI 5901002288) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00433) | |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2022-07-21 |