| NPI | 1568485787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 1134) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AR 126) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-05-30 |