| NPI | 1407824410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO02633) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO2633) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2023-01-09 |