| NPI | 1326620154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MT MED-POD-LIC-142134) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MT 142134) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2026-03-26 |