| NPI | 1952752891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 1074) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1161-25) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-02-16 |