| NPI | 1013906171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1971) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: MA 1971) |
| 213ES0131X Podiatrist Foot Surgery (Licence: MA 1971) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2008-01-07 |