| NPI | 1790852895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 467) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 467) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 467) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-04-03 |