| NPI | 1902895881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4282) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006130) |
| 213E00000X Podiatrist (Licence: WA PO00000808) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO00000808) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2024-03-25 |