| NPI | 1386178705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301310) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5678) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-08-22 |