| NPI | 1710958715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000014) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: DC PO1000014) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: DC po1000014) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2020-12-04 |