| NPI | 1982992517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 604) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 00381) |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2017-11-16 |