| NPI | 1407825029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 935) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 935) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC004777R) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2019-05-14 |