| NPI | 1700868643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 0607) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 2301) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO2949) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2023-05-13 |