| NPI | 1407810575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO 0000909) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NM 467) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ND 48) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-10-27 |