| NPI | 1023112588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 772) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 772025) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2015-03-18 |