| NPI | 1225034176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO1182) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: FL PO1182) |
| 213ES0131X Podiatrist Foot Surgery (Licence: FL PO1182) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-07-20 |