| NPI | 1720728710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 862) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 862) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-12-29 |