| NPI | 1003826306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO 1128) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO1128) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 1128) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-02-10 |