| NPI | 1376040162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: HI PO-242) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5784) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-08-25 |