| NPI | 1811914815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 1092.25) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 958) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT 162) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-02-22 |