| NPI | 1033165642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103001046) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC002084L) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: LA 200007) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-04-08 |