| NPI | 1891150777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CO 0000554) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX 2329) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2024-10-10 |