| NPI | 1548757800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4392) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301320) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103301320) | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2022-06-29 |