| NPI | 1114048204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 586-025) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 586-025) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2009-02-04 |