| NPI | 1669483517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3257) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: FL PO3257) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3257) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-11-20 |