| NPI | 1104383512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4242) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4242) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4242) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO4242) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO4242) | |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2024-02-19 |