| NPI | 1275537607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: AZ POD-000599) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ POD-000599) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ POD-000599) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: AZ POD-000599) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-04-29 |