| NPI | 1952735219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4081) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: RI 00347) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: RI 00347) | |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2024-10-16 |