| NPI | 1326305509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MT 40884) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CO POD.0000763) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO POD.0000763) | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2022-07-21 |