| NPI | 1063697928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ND 65) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: LA DPM.200037) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT 171) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2013-02-12 |