| NPI | 1003864042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO 2285) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 2285) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2008-09-16 |