| NPI | 1568776334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 000877) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 000877) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006209) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2022-12-13 |