| NPI | 1912588377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 0001112) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ 0001112) |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2024-08-20 |