| NPI | 1184064834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3765) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006507) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3765) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2023-05-12 |