| NPI | 1144843111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4608) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4608) |
| 213ES0131X (Licence: FL PO4608) | |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2024-09-24 |