| NPI | 1548754930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 759) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 283676) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 768) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-06-11 |