| NPI | 1326017179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3945) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WY 127) |
| 213E00000X Podiatrist (Licence: FL PO3945) | |
| 213ES0131X (Licence: WY 127) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-03-31 |