| NPI | 1295354033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4565) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO POD0000921) |
| 213E00000X Podiatrist (Licence: FL PD4565) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.004160) | |
| Enumeration Date | 2020-04-12 |
| Last Update Date | 2026-05-04 |