| NPI | 1295284354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD000925) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2019-07-16 |