| NPI | 1578525820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: SC 130) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: SC 130) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2020-10-13 |