| NPI | 1699763938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NE 301) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 00675) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 301) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-09-20 |