| NPI | 1174078109 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3710) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3710) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3710) | |
| 213EP0504X Podiatrist, Public Medicine (Licence: FL PO3710) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO3710) | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2025-02-03 |