| NPI | 1750744355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103301285) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301285) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2024-01-19 |