| NPI | 1891374302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4464) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4464) |
| 213E00000X Podiatrist (Licence: FL PO4464) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO4464) | |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2024-05-25 |