| NPI | 1821483223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01639) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 01639) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2018-06-27 |