| NPI | 1144683368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001492A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006989) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 297742) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2025-05-20 |