| NPI | 1780978296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301104) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103301104) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2019-09-02 |