| NPI | 1477731313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL 296) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AL 296) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AL 296) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3271) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: AL 296) | |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2019-08-27 |