| NPI | 1942645270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD P006944) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000130) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2022-07-13 |