| NPI | 1881048205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NV 2052) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2020-06-17 |