| NPI | 1811981681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MT 105) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ND 30) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-11-12 |