| NPI | 1639249782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV 2061) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 10197768-0501) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD000886) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-11-16 |