| NPI | 1275067654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX 3071) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD-001061) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 356) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2025-04-15 |