| NPI | 1326195504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 519) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NC 519) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2021-02-18 |