| NPI | 1033104062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 000281) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL POOOO2293) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2025-04-03 |