| NPI | 1780658427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: MA PD 1969) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: MA PD 1969) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2025-03-17 |