| NPI | 1942641618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 01648) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3783) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006488) | |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2025-07-01 |