| NPI | 1609281534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP217875) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001532) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003811) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-01-17 |