| NPI | 1407189244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001147) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: IA 000834) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2024-09-27 |