| NPI | 1902185051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1017-25) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 850) |
| 213E00000X Podiatrist (Licence: WI 1017-25) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 850) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 1017-25) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 850) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2021-05-18 |