| NPI | 1871899922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006256) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006889) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301223) | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2019-08-13 |