| NPI | 1982967287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301135) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0116024662) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-06-10 |