| NPI | 1649532912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4266) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: LA DPM.200046) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2049) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2021-03-02 |