| NPI | 1801862149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 00578) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103000458) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-01-11 |