| NPI | 1720213598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0736) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0736) |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2024-06-20 |