| NPI | 1710204862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: FL PO3837) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00362) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2017-04-26 |