| NPI | 1104130574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: UT 8400193-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NV 2109) |
| 213E00000X Podiatrist (Licence: CA E5797) | |
| 213E00000X Podiatrist (Licence: FL PO4406) | |
| 213E00000X Podiatrist (Licence: GA POD001473) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: UT 8400193-0501) | |
| 213ER0200X Podiatrist, Radiology (Licence: UT 8400193-0501) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: UT 8400193-0501) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 8400193-0501) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2024-06-17 |