| NPI | 1467732271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0783) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ na) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2021-09-16 |