| NPI | 1295003465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2076) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OK 316) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2020-10-01 |