| NPI | 1487656104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO2417) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO8041) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2020-01-03 |