| NPI | 1275780199 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001142) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 006294) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA POD001142) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2024-12-16 |