| NPI | 1831481035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3747) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AR 256) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 3120) | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2024-11-08 |