| NPI | 1053335083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000509) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: CT 000509) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000509) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT 000509) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-10-30 |