| NPI | 1639750128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: AK 236930) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MT 121160) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2025-07-16 |