| NPI | 1750316642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103300842) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 00365) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-11-21 |