| NPI | 1851381065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 1625) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1652) |
| 213ES0131X (Licence: MA 1625) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2021-03-30 |