| NPI | 1376543686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 685) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1210) |
| 213E00000X Podiatrist (Licence: AZ 128) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2021-05-06 |