| NPI | 1699883009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 00666) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NE 303) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 303) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IA 00666) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2024-11-04 |