| NPI | 1932106713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ID P-156) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: LA PD176R) |
| 213E00000X Podiatrist (Licence: ID P-156) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-08-05 |