| NPI | 1679545172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 333) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MT 136; Ankle Lic 14) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-06-16 |