| NPI | 1679205280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01797) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VA 0116036841) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-04-09 |