| NPI | 1376982199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP191824) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T46-2013) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-09-30 |