| NPI | 1811384530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01712) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001421) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01712) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-02-16 |