| NPI | 1780942045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 1155-25) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000941) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5207) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2019-07-12 |