| NPI | 1417903550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0579) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: AZ 0579) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-10-01 |