| NPI | 1104970862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 3020) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: LA DPM.200036) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: LA DPM.200036) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA DPM.200036) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: LA DPM.200036) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-06-10 |