| NPI | 1760487441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NH 0193) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ME POD190) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ME POD 190) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 1842) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-03-09 |