| NPI | 1982075685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD000906) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ POD000906) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA EL6759) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2022-05-03 |