| NPI | 1720019482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: NC 410) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 410) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-02-16 |