| NPI | 1720341787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006702) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY P71514) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60300334) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2017-05-18 |