| NPI | 1164514550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 3115) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3115) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4857) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 000800) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016-005286) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N 006159) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2023-11-16 |