| NPI | 1396164372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: MD 1646) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 1646) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: VA 103301247) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2020-11-17 |