| NPI | 1699939116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2026) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006062) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO POD.0000790) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2018-10-02 |