| NPI | 1518327089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 108136) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: IA 415300059) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2022-06-09 |