| NPI | 1841462421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0672) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0672) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2024-06-06 |