| NPI | 1437577913 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006592) | 
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA sc006592) | 
| Enumeration Date | 2014-04-02 | 
| Last Update Date | 2025-05-13 |