| NPI | 1053580696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: VA 0103301014) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WV 10402) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WV 10402) | |
| 213E00000X Podiatrist (Licence: OH 36-003486) | |
| 213E00000X Podiatrist (Licence: VA 0103301014) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2009-10-01 |