| NPI | 1770998478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4019) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NV 2024) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0116027378) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2019-01-09 |