| NPI | 1396304820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NM POD2024-0004) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36.004088) |
| 213E00000X Podiatrist (Licence: NM POD2024-0004) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36.004088) | |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2024-08-05 |