| NPI | 1942497243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ND 58) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 6731358-0501) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2018-09-07 |