| NPI | 1336448125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 627) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SC 627) |
| 213ES0131X Podiatrist Foot Surgery (Licence: SC 627) | |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2022-09-20 |