| NPI | 1699773176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO-0002641) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO-0002641) |
| 213ER0200X Podiatrist, Radiology (Licence: FL PO-0002641) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO-0002641) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO-0002641) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-08-26 |