| NPI | 1023172426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CO 665) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 5943612-0501) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-04-16 |