| NPI | 1043411523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WY 145) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2007005956) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SD 218) | |
| 213E00000X Podiatrist (Licence: SD 218) | |
| 213E00000X Podiatrist (Licence: MO 2007005956) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2014-06-19 |