| NPI | 1134100456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ME POD1044) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ME POD 1044) |
| 213ER0200X Podiatrist Radiology (Licence: ME POD 1044) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: ME POD 1044) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ME POD 1044) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2019-04-26 |