| NPI | 1376031526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 743) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: SC 743) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-06-29 |