| NPI | 1639599053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL 399) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PR370) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2024-07-30 |