| NPI | 1669438602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: AL 272) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AL 272) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: AL 272) | |
| 213E00000X Podiatrist (Licence: AL 272) | |
| 213EP0504X Podiatrist Public Medicine (Licence: AL 272) | |
| 213ER0200X Podiatrist Radiology (Licence: AL 272) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: AL 272) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AL 272) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-07-23 |