| NPI | 1730176249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 691) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 01657) |
| 213ES0131X Podiatrist Foot Surgery (Licence: FL PO3942) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2020-09-24 |