| NPI | 1629207261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 345) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SD 206) |
| 213E00000X Podiatrist (Licence: IA 000820) | |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2017-08-16 |