| NPI | 1013947977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL PO1202) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: FL PO1202) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-05-07 |