| NPI | 1770149676 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01767) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10517) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2023-10-13 |