| NPI | 1528592094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: DC PO1000185) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001449) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-10-19 |