| NPI | 1710363692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PR450) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: FL PR450) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PR450) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3970) | |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2019-11-26 |