| NPI | 1740272491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2166) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 2166) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 00782) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-05-20 |