| NPI | 1477511350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL po3354) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001025A) |
| 213E00000X Podiatrist (Licence: MO 2004021616) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2026-04-08 |