| NPI | 1356637409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 8369993-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ID P-249) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NV 2057) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2024-02-05 |