| NPI | 1932763927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103301346) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301346) |
| 213ES0000X Podiatrist Sports Medicine (Licence: VA 0103301346) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: VA 0103301346) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-04-14 |