| NPI | 1639274301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103000815) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: VA 0103000815) |
| 213ES0000X Podiatrist Sports Medicine (Licence: VA 0103000815) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103000815) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: VA 0103000815) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: VA 0103000815) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-11-28 |