| NPI | 1992200331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID 2961061) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AR 279) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-08-06 |