| NPI | 1114238953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2357) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006187) |
| 213E00000X Podiatrist (Licence: FL PO3607) | |
| Enumeration Date | 2010-06-26 |
| Last Update Date | 2025-05-01 |