| NPI | 1295044212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ND 68) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX T40-2010) |
| Enumeration Date | 2010-09-26 |
| Last Update Date | 2024-05-10 |