| NPI | 1295394732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 749) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007045) |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2023-10-27 |