| NPI | 1487815684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 572) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 572) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 572) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2021-05-06 |