| NPI | 1467868257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 01762) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA 308647) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006590) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2023-10-12 |