| NPI | 1821351263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 2428) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 1280) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2019-10-14 |