| NPI | 1801839964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 580) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC 004687L) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25 MD00278700) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-07-09 |