| NPI | 1588928444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301127) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301127) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103301127) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006378) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2020-12-02 |