| NPI | 1275276354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2025026923) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 113699) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: MO 2025026923) | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-08-05 |