| NPI | 1518196054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301024) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC004681L) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N006227-1) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2023-01-27 |