| NPI | 1487917340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ND 77) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0116024929) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-10-26 |