| NPI | 1427025311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2004013247) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO4199) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016005170) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AR 250) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-11-15 |