| NPI | 1639492473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 603) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001109) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2019-10-17 |