| NPI | 1497208565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5554) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006721) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2020-01-30 |