| NPI | 1912529306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID P-293) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM POD22011) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-08-04 |