| NPI | 1679860548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SD 229) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006320) |
| 213E00000X Podiatrist (Licence: MN 921) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-03-04 |