| NPI | 1285653592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO1312) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL PO1312) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-05-01 |