| NPI | 1518380872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000813) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP174057) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2018-03-21 |