| NPI | 1205221017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO POD.0000908) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM POD.468) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002564) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2024-02-05 |