| NPI | 1043227390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO CO 526) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CO CO 526) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CO CO 526) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO CO526) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2016-11-21 |