| NPI | 1881697886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 00941) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 00941) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-11-02 |