| NPI | 1679851208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001240) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2019-09-10 |