| NPI | 1902464027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SD 249) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 096109) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2024-08-13 |