| NPI | 1578058962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 92505) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 92505) |
| 213E00000X Podiatrist (Licence: CA E5741) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IA 92505) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E5741) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5741) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E5741) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-06-07 |