| NPI | 1700848348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000539) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: MO 000539) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MO 000539) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 000539) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2020-03-16 |