| NPI | 1760644249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 596) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 549) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 1127) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2015-03-16 |