| NPI | 1720079528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 374325-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0542) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID p-289) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-07-23 |