| NPI | 1841630175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 2449) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1300) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2020-10-29 |