| NPI | 1285980094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 9293096-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PODL.PL.60302986) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2015-12-02 |