| NPI | 1295702108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0130000659) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0130000659) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0130000659) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0130000659) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2020-03-03 |