| NPI | 1962513820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 0601) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0616) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4715) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-11-23 |