| NPI | 1538108675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: LA 304113) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 278) |
| 213E00000X Podiatrist (Licence: CA E5177) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AL 278) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36 003501) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-07-23 |