| NPI | 1639161946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NC 400) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: SC 510) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2019-02-13 |