| NPI | 1265545966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MO 2208014928) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NE 316) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: KS 1200374) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-11-11 |