| NPI | 1750817714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OR DP198814) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX NOT YET ISSUED) |
| 213E00000X Podiatrist (Licence: OR DP198814) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: TX NOT YET ISSUED) | |
| 213ER0200X Podiatrist Radiology (Licence: TX NOT YET ISSUED) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-10-28 |