| NPI | 1760613004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AR 261) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006137) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MT 18523) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MT 18523) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2019-10-17 |