| NPI | 1023013760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OK 201) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ID P-155) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005469) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2014-10-28 |