| NPI | 1649667791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 695) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2306) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2023-10-16 |