| NPI | 1558566208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 000801) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA T00801) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2023-09-07 |