| NPI | 1942565239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 10434) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 10434) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2021-08-16 |