| NPI | 1902241268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1165) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1085-25) |
| 213E00000X Podiatrist (Licence: OR DP201954) | |
| 213E00000X Podiatrist (Licence: IL 016005725) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OR DP201954) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005725) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1085-25) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2024-09-19 |