| NPI | 1952433849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO 00000822) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N006201) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2016-04-05 |