| NPI | 1114923463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WY 104) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WY 104) |
| 213ER0200X Podiatrist, Radiology (Licence: WY 104) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: WY 104) | |
| 213E00000X Podiatrist (Licence: WY 104) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: WY 104) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-03-28 |