| NPI | 1124256151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60217479) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 41000232A) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2013-07-23 |