| NPI | 1063458404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: FL P00001617) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL P00001617) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2014-07-21 |