| NPI | 1124089842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3515) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: FL PO3515) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO3515) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2024-06-06 |