| NPI | 1679937056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01782) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2395) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2025-04-09 |