| NPI | 1003804832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO OOO1517) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO1517) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2020-04-17 |