| NPI | 1427160902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5384) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 1344) |
| 213E00000X Podiatrist (Licence: AZ 0536) | |
| 208D00000X General Practice (Licence: AZ TL098) | |
| 213E00000X Podiatrist (Licence: CA E4402) | |
| 213E00000X Podiatrist (Licence: IL 016-005205) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-11-27 |