| NPI | 1871023960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 713) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VT 061.0000023) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2022-11-12 |