| NPI | 1033105275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P127) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: ID P127) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2020-02-24 |