| NPI | 1831506146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301172) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL6674) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2019-06-28 |