| NPI | 1912933474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: MO 000747) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 000747) |
| 213ES0131X Podiatrist Foot Surgery (Licence: KS 12-00294) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-12-23 |