| NPI | 1578819215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 3144) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AK 8340) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2024-02-20 |