| NPI | 1750951406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SC 771) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 850) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007170) | |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2024-07-07 |