| NPI | 1609801687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3311) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: FL PO3311) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3311) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-11-10 |