| NPI | 1013929660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist Sports Medicine (Licence: CO CO335) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CO CO335) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO CO335) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2011-10-17 |