| NPI | 1295732741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO 2501) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: FL P02501) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL P02501) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2025-11-06 |