| NPI | 1881657740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO1101) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL FP1101) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO1101) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO1101) | |
| 213ER0200X Podiatrist, Radiology (Licence: FL PO1101) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2016-02-23 |