| NPI | 1306175104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 082885) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 329) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IA 082885) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2009017428) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2018-12-04 |