| NPI | 1952714313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 979) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CO 798) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO PDT.0000539) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-01-19 |