| NPI | 1689027054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OR DP207320) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 000930) |
| 213E00000X Podiatrist (Licence: TX T60-2016) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2021-11-17 |