| NPI | 1457772774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA DPM.200054) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: LA DPM.200054) |
| 213E00000X Podiatrist (Licence: LA PCTA.000048) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: LA PCTA.000048) | |
| Enumeration Date | 2014-01-05 |
| Last Update Date | 2023-08-30 |