| NPI | 1316476161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301297) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103301297) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103301297) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2024-01-29 |