| NPI | 1306107313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 757) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 13735196-0501) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001272) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-12-21 |