| NPI | 1598853970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TN 663) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001113) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-09-24 |