| NPI | 1700967924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AL 154) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AL 154) |
| 213EP0504X Podiatrist, Public Medicine (Licence: AL 154) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AL 154) | |
| 213ER0200X Podiatrist, Radiology (Licence: AL 154) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: AL 154) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: AL 154) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-08-19 |