| NPI | 1780029231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-246) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OR DP176570) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP176570) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-10-03 |