| NPI | 1821402157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP188848) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3866) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MI 5901002519) | |
| Enumeration Date | 2014-06-14 |
| Last Update Date | 2021-02-12 |