| NPI | 1669112868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 408) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 12-00506) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5951001462) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-06-13 |