| NPI | 1710491766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301317) |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2026-08-25 |