| NPI | 1750386496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103000893) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103000893) |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2022-11-29 |