| NPI | 1578778213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0421) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: AZ 0421) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: AZ 0421) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-28 |