| NPI | 1588839534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 3121) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: TX 3121) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 1025-25) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 820) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2021-10-27 |