| NPI | 1669803193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV 2018) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NV 2018) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 2018) | |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2018-06-11 |