| NPI | 1992020432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID P-282) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2008027655) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WY 141) | |
| Enumeration Date | 2010-03-27 |
| Last Update Date | 2023-09-27 |