| NPI | 1821409632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: PA sc006938) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006938) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2018-11-06 |