| NPI | 1831330323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NE 364) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36.003511) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3391) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NE 364) | |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2022-03-10 |