| NPI | 1417983222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2024022221) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1986) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4609) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-12-18 |