| NPI | 1114135977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO-1815) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: AL 121) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |