| NPI | 1992742118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NV DPM9501) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: NV DPM9501) |
| 213ES0131X Podiatrist Foot Surgery (Licence: NV DPM9501) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-12-15 |