| NPI | 1548758816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 286397) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VT 061-000027) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2025-08-09 |