| NPI | 1336720010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4563) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: FL PR694) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PR694) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2024-04-15 |