| NPI | 1679867428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3659) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3659) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2018-02-05 |