| NPI | 1871283093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ POD-001102) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 455) |
| 213E00000X Podiatrist (Licence: AZ POD-001102) | |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2025-06-25 |