| NPI | 1265471890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 545) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 545) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 545) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2026-07-08 |