| NPI | 1538149471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ME POD1019) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: ME POD1019) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2024-09-18 |