| NPI | 1831772441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4518) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PR710) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2023-07-20 |