| NPI | 1437717857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 790) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VT 056.0000200) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2025-06-18 |