| NPI | 1245486307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 7930013-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NV 1104) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2024-09-25 |