| NPI | 1285074997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: SD 230) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NE 358) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 081746) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2017-08-22 |