| NPI | 1992188452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301240) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX t67-2015) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2018-09-11 |