| NPI | 1346717212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 817) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 817) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD001507) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-08-23 |