| NPI | 1346736022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 106716) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2018023329) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2021-07-13 |