| NPI | 1932764016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 797) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 797) |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 797) | |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2022-08-09 |