| NPI | 1942525738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80221) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00351) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001191) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2014-09-09 |