| NPI | 1609972439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR dp00442) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP00442) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-02-18 |