| NPI | 1104033703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: DC PO1000031) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO1000031) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-05-03 |