| NPI | 1902053358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT 16274) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AK 6850) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 7081425-0501) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2020-07-22 |