| NPI | 1164425013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NC 388) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 388) |
| 213ES0131X Podiatrist Foot Surgery (Licence: NC 388) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2024-06-24 |