| NPI | 1992190524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: AL 367) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001271A) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-08-05 |