| NPI | 1942231568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NH 0221) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NH 0221) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NH 0221) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-10-03 |