| NPI | 1942628813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01645) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301238) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 003798) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000149) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-07-21 |