| NPI | 1376936591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2018045497) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO POD.0000802) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KS 12-00450) | |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2019-04-02 |