| NPI | 1548223647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO1949) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: FL PO01949) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2025-03-07 |