| NPI | 1003896374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 12-00358KS) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD2185) |
| 213E00000X Podiatrist (Licence: MO 2006023557) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2012-10-18 |