| NPI | 1003996901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60013996) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TN DPM0000000668) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 56793490501) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4772) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-02-11 |