| NPI | 1326047846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO2948) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 257) |
| 213E00000X Podiatrist (Licence: LA PD0103) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 2948) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2023-02-16 |