| NPI | 1144615527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4091) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4091) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2024-11-15 |