| NPI | 1619397643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3892) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3892) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL PO3892) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: FL PO3892) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: FL PO3892) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2024-08-12 |