| NPI | 1891058921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103301147) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 1284) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2015-08-28 |