| NPI | 1760802268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001419) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 59.000515) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003886) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-01-31 |