| NPI | 1295726172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: SC 565) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SC 565) |
| 213E00000X Podiatrist (Licence: TN 847) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TN 847) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: TN 847) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: SC 565) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-03-07 |