| NPI | 1043212566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: FL PO 1505) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 1505) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO 1505) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO 1505) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2010-04-05 |