| NPI | 1689661266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103300819) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: VA 010303300819) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-10-31 |