| NPI | 1659431583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4541) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000934) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N004660) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2025-04-08 |