| NPI | 1568448801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0381) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0381) |
| 213E00000X Podiatrist (Licence: CA EFE3362) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-03-07 |