| NPI | 1487093746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ POD-000927) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: UT 9065045-0501) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 9065045-0501) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2020-06-18 |