| NPI | 1124376389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SD 223) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO 3554) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006440) | |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2014-08-07 |