| NPI | 1649629817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 3062) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T36-2016) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4049) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2023-11-09 |