| NPI | 1598818296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 1006) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: KY 00339) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC005780) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2021-07-20 |