| NPI | 1023001492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3077) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3077) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2021-01-18 |