| NPI | 1770969875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: SD 245) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: FL PO3985) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO3985) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3985) | |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2022-02-28 |