| NPI | 1831450436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: VA 0103301162) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301162) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2026-01-19 |