| NPI | 1477905446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 2483) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 2483) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2023-11-08 |