| NPI | 1265838668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CO POD.0000887) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N006717-1) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2022-01-17 |