| NPI | 1962630004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3551) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY P77589) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006136) | |
| Enumeration Date | 2009-06-28 |
| Last Update Date | 2022-12-20 |