| NPI | 1568807212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5000) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00401) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2015-12-14 |