| NPI | 1629066089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0388) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0388) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2019-12-17 |