| NPI | 1780768705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: VA 0103300932) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: VA 0103300932) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103300932) | |
| 213E00000X Podiatrist (Licence: VA 0103300932) | |
| 213ER0200X Podiatrist, Radiology (Licence: VA 0103300932) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: VA 0103300932) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-05-02 |