| NPI | 1598262479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC POD.740) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007160) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2022-07-05 |