| NPI | 1104807411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MT MED-POD-LIC-122) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MT 122) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2025-09-26 |