| NPI | 1518225929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID P242) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000757) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2020-02-11 |